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TUNISHA20

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hi,
I had a pt. have spine surgery Arthrodesis which was not completed. We billed modifer 53. A month later the same procedure was performed and completed. What modifer will I bill for 2nd procedure?
can someone help me??
 
Hi Tunisha,

First of all, why did you append modifier 53 ??? I am asking this because these procedures are generally performed in an outpatient ASC setting (not in office) and that requires a usage of 73 or 74 modifier.

As far as your question goes, you should append modifier 78 with arthrodesis code, as the patient is still in a global period with other appropriate modifiers to follow, if any.

For any other information or any other doubts or question, do let me know. Would be more than happy to help you.

Thank you,
Rajinder Singh Dhammi, CPC, CPB
e-mail: rajinder_dhammi@yahoo.com
 
Coder is not intimating the procedure was performed in the office by asking whether modifier 53 is appropriate. Arthrodesis procedures may be performed as IP, OP or in an ASC. It would depend on comorbidities and other factors as appropriate as to where the surgery took place. For IP or OP, modifier 53 could be entirely appropriate.
It would be helpful to know why the proposed procedure was not completed. If due to instability of the patient's condition then modifier 53 is correct, but if the provider felt it would be better to complete it in stages and this is documented, modifier 52 could have been used instead, and documentation would support modifier 58 on the return to the OR.
 
Rajinder_Dhammi said:
Hi Tunisha,

First of all, why did you append modifier 53 ??? I am asking this because these procedures are generally performed in an outpatient ASC setting (not in office) and that requires a usage of 73 or 74 modifier.

As far as your question goes, you should append modifier 78 with arthrodesis code, as the patient is still in a global period with other appropriate modifiers to follow, if any.

For any other information or any other doubts or question, do let me know. Would be more than happy to help you.

Thank you,
Rajinder Singh Dhammi, CPC, CPB
e-mail: rajinder_dhammi@yahoo.com
Click to expand...
Rajinder_Dhammi said:
Hi Tunisha,

First of all, why did you append modifier 53 ??? I am asking this because these procedures are generally performed in an outpatient ASC setting (not in office) and that requires a usage of 73 or 74 modifier.

As far as your question goes, you should append modifier 78 with arthrodesis code, as the patient is still in a global period with other appropriate modifiers to follow, if any.

For any other information or any other doubts or question, do let me know. Would be more than happy to help you.

Thank you,
Rajinder Singh Dhammi, CPC, CPB
e-mail: rajinder_dhammi@yahoo.com
Click to expand...
Hello Rajinder, thank you for your reply. The procedure was done at an out patient ambulatory Center. The procedure was stop due to patient being hypotensive.
we billed: 22551, 22552, 22853, 22845,20930, 20936, 69990 for 1st & 2nd procedure. I added modifier 53 to 1st procedure, is this wrong?
(also 2nd procedure performed in hospital inpatient)
ok, your saying to bill 78 for 2nd procedure? but it was not an unplanned procedure, it was scheduled.

I appreciate all your help.
 
twizzle said:
Coder is not intimating the procedure was performed in the office by asking whether modifier 53 is appropriate. Arthrodesis procedures may be performed as IP, OP or in an ASC. It would depend on comorbidities and other factors as appropriate as to where the surgery took place. For IP or OP, modifier 53 could be entirely appropriate.
It would be helpful to know why the proposed procedure was not completed. If due to instability of the patient's condition then modifier 53 is correct, but if the provider felt it would be better to complete it in stages and this is documented, modifier 52 could have been used instead, and documentation would support modifier 58 on the return to the OR.
Click to expand...
Hello,
The procedure was done at an out patient ambulatory Center. The procedure was stop due to patient being hypotensive.
we billed: 22551, 22552, 22853, 22845,20930, 20936, 69990 for 1st & 2nd procedure. I added modifier 53 to 1st procedure, is this wrong?
(also 2nd procedure performed in hospital inpatient)
ok, your saying to bill 78 for 2nd procedure? but it was not an unplanned procedure, it was scheduled.

I appreciate all your help.
 
TUNISHA20 said:
Hello Rajinder, thank you for your reply. The procedure was done at an out patient ambulatory Center. The procedure was stop due to patient being hypotensive.
we billed: 22551, 22552, 22853, 22845,20930, 20936, 69990 for 1st & 2nd procedure. I added modifier 53 to 1st procedure, is this wrong?
(also 2nd procedure performed in hospital inpatient)
ok, your saying to bill 78 for 2nd procedure? but it was not an unplanned procedure, it was scheduled.

I appreciate all your help.
Click to expand...
sorry anesthesia was administered during 1st cancelled procedure
 
twizzle said:
Coder is not intimating the procedure was performed in the office by asking whether modifier 53 is appropriate. Arthrodesis procedures may be performed as IP, OP or in an ASC. It would depend on comorbidities and other factors as appropriate as to where the surgery took place. For IP or OP, modifier 53 could be entirely appropriate.
It would be helpful to know why the proposed procedure was not completed. If due to instability of the patient's condition then modifier 53 is correct, but if the provider felt it would be better to complete it in stages and this is documented, modifier 52 could have been used instead, and documentation would support modifier 58 on the return to the OR.
Click to expand...
sorry anesthesia was administered during 1st cancelled procedure
 
Modifier 73 and 74 is used for the facility side only, and only for ASC or outpatient hospital.
73 - discontinued after the patient's surgical preparation but before the induction of anesthesia
74 - discontinued after induction of anesthesia or after the procedure was started

If you are billing for the physician, you would not use these modifiers. Rajinder is incorrect.
 
SharonCollachi said:
Modifier 73 and 74 is used for the facility side only, and only for ASC or outpatient hospital.
73 - discontinued after the patient's surgical preparation but before the induction of anesthesia
74 - discontinued after induction of anesthesia or after the procedure was started

If you are billing for the physician, you would not use these modifiers. Rajinder is incorrect.
Click to expand...

Dear Sharon,

Kindly read the whole post carefully before commenting if someone is incorrect.

I never stated you would use 73 or 74 for office procedures. They are specially reserved for ASC procedures.

That's the reason I asked Tunisha, "why did you append modifier 53 ??? I am asking this because these procedures are generally performed in an outpatient ASC setting (not in office) and that requires a usage of 73 or 74 modifier."

I hope I am clear Sharon.

Thank you,
Rajinder Singh Dhammi, CPC, CPB
 
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